Protecting Ourselves from the Threat of Ebola: Lessons from History

CPH Board Certified Allergy Asthma, Immunology Specialist

On a fateful October day of 1347, when the 12 Genoese ships, after a long journey through the Black Sea, arrived at the Sicilian port city of Messina, most of the sailors were dead with their corpses covered by black boils; five years thereafter, one-third of Europe’s population (about 20 million) was dead by a hitherto unknown bacillus, spread like wildfire on the wings of fleas and rodents. The tremendous societal impact of that mass death still resonates in today’s lullaby, ‘Ring around the rosy, A pocketful of posies, Ashes to Ashes, We all fall down.’

Epidemics of gargantuan proportion have changed the course of history in the new world; the deadliest weapon Columbus and his successor brought to the Americas was not guns, nor armor nor superior war tactics — it was the old-world disease, small pox to be precise, that conquered the Aztecs and the Incas.

Yes, it is not in sci-fi movies alone — it is all over in human history too. And this brings us to today’s story of evolving Ebola. First recognized in 1976 near the Ebola river valley in Zaire, this old-world malady is now again in the new world, killing one and infecting another, a healthcare provider to be precise, despite the best possible personal protective gear that the richest country in the world can offer, and thus giving the public health aficionados from CDC to the ivory towers of healthcare a real chill. Entry points like airports remain at a heightened alert. Scientists in labs are scrambling. Despite the whirlwind of untoward news from the Iraq and Syria and Afghanistan, the US president is gravely concerned and dispatched a large contingent of military personnel to the North African hot-bed of Ebola to contain the spread. It is a difficult mission and albeit, a potentially deadly one.

Ebola is not a respiratory virus like the H1N1 influenza virus of 1818-1819 that killed up to 50 million to 100 million souls. Like HIV, it is not a silent virus that spreads surreptitiously. Hence, countries with good public health infrastructure, despite some initial glitches, eventually will contain and conquer Ebola. However, in developing countries like those in West Africa, with still-rudimentary public health infrastructure Ebola can be quite menacing.

According to the WHO Ebola Roadmap Situation Report of October 8, epidemiologically at risk countries fall in three categories: (1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); (2) those with an initial case or cases, or with localized transmission (Nigeria, Senegal, and the US) and (3) those countries that neighbor areas of active transmission (Benin, Burkina Faso, Cote d’lvoire, Guinea-Bissau, Mali, Senegal). Exclusion from this list, however, should not lead to complacency on any country’s part. It is of note that one United Nations employee, who contracted Ebola in Liberia, succumbed in a Leipzig hospital in Germany. Couple this information with the news of inept handling of travelers arriving from North Africa in the early days of the outbreak, and any sane politician and/or public health official should feel a chill in the spine.

We must remember that it is not very easy to contract Ebola. Standard infection control protocol was felt to be enough of a protection until the healthcare worker in Dallas, Texas contacted the disease. The Centre for Disease Control (CDC) in Atlanta, USA is now rethinking about the standard protocol. Based on information from September 2014, the CDC also predicts that as many as 550,000 to 1.4 million can be infected with Ebola by January. With the US sending additional help to West Africa, this number hopefully will be tamed down. However, the bottom line is clear: that before the outbreak is contained, chance of getting the virus other “underdeveloped” countries and in the US—however remote that chance is—is real. The world is now a small economic whole. We travel at jet speed and in every nook and cranny, and yes, in North Africa too.

Doses of ZMapp that helped cure two Americans at Emory in Atlanta are exhausted. TKM-Ebloa has showed some promise and is on fast track for development. Brincidofovir, another antiviral did not help Mr. Eric Duncan in Dallas; maybe it was belated by too many days. No, there is no cure for Ebola yet! Two vaccines (one developed in the USA and the other in Canada) are being tested, and only time shall tell — time, however, is not plentiful, especially for the people of West Africa.

And it is to West Africa that we must turn our attention. Until the epidemiological principles are satisfied and at least 70 per cent of the patients with Ebola are cared for appropriately, the epidemic is here to stay and we’d better anticipate its eventual arrival on a larger scale, continue vigilance, screen arrivals at airports and at hospitals and clinics, and plan for the worst.

Dr. Mohammad (Akhtarazaman) Zaman, is a board-certified allergy, asthma, immunology specialist at Canton-Potsdam Hospital with an office in the E. J. Noble Professional Building in Canton. Earlier in 2014, Dr. Zaman was appointed to serve on the Integrative Medicine Committee, Sports Medicine Committee, and Indoor Environment Committee of the American College of Allergy, Asthma, & Immunology, the national professional association representing 5,700 allergists/immunologists. He writes frequently about health issues, especially about the body’s ability to fight off disease. Dr. Zaman may be contacted at 315-714-3170.